Rosacea triggers: how to find and avoid yours

A rosacea trigger is anything that makes rosacea flare. Common triggers include the sun, heat, hot drinks, alcohol, spicy food, stress, wind, cold, exercise and some skin care products. The American Academy of Dermatology (AAD) says triggers differ from person to person, so the list that matters is your own. This guide covers each common trigger, what the AAD, the NHS and the US National Institutes of Health (NIH) suggest for it, and a simple way to find yours. It assumes a doctor has already confirmed rosacea. If you have not been diagnosed, see a doctor first, because many other conditions cause a red face.

For the basics of the condition, read what rosacea is.

Why triggers matter

The AAD says rosacea makes the skin sensitive, so many things can cause it to flare. Each flare is more than a short problem. The AAD says each time your skin flushes, it can stay red for longer. In some people, repeated flushing leads to skin that stays red. Visible blood vessels may appear, and skin can thicken.

Repeated flushing can also make treatment harder. The AAD says a treatment that worked earlier may stop working, and a dermatologist may need to try something stronger. This is why dermatologists often ask patients to find their triggers before treatment starts.

The common triggers at a glance

Trigger	Named by	What the AAD suggests
Sunlight	AAD, NHS, NIH	Daily sunscreen, SPF 30 or higher, a wide-brim hat, shade
Heat and hot baths	AAD, NHS, NIH	Warm showers instead of hot, dress in layers
Hot drinks	AAD, NHS, NIH	Iced tea or coffee, or let drinks cool to lukewarm
Alcohol, especially red wine	AAD, NHS, NIH	White wine instead of red, 1 or 2 drinks at most, or none
Spicy food	AAD, NHS, NIH	Try a mild version first
Stress	AAD, NHS, NIH	A regular calming activity, slow breathing
Wind and cold	AAD, NIH (NHS names cold)	A silk or acrylic scarf over the lower face
Exercise	AAD, NHS, NIH	Lower intensity, cool places, cool water
Some skin, hair and makeup products	AAD	Check ingredient lists, stop toners and astringents
Some medicines	AAD	Ask the prescribing doctor, never stop on your own

Sun

The AAD says the sun can worsen rosacea at any time of year, and that it is one of the most frequent causes of a flare for people of all skin tones. It says a few minutes of sunlight on rosacea-prone skin can lead to flushing and redness that are hard to control.

The AAD recommends a gentle, broad-spectrum sunscreen with an SPF of 30 or higher every day. Broad-spectrum means it protects against both types of the sun's harmful rays. A fragrance-free sunscreen with zinc oxide, titanium dioxide or both is the least likely to irritate, the AAD says. Add a wide-brim hat, stay out of the midday sun and use shade. The guide to sunscreen for rosacea covers how to choose one.

Heat, hot drinks and hot baths

The AAD says anything that raises your body temperature can trigger rosacea. Heat, hot baths and hot drinks are on the lists from all three sources.

To avoid overheating, the AAD suggests:

• Warm baths and showers instead of hot ones
• Dressing in layers so you can remove clothing when you get warm
• Sitting far enough from fireplaces and heaters that you do not feel the warmth
• A cold, wet cloth around the neck, a cold drink, a fan or air conditioning when you feel too hot

For hot drinks, the AAD says the heat of the drink causes some people's rosacea to flare. It suggests iced coffee or tea, or letting a drink cool until it is warm or lukewarm.

Alcohol and spicy food

The AAD says red wine may be the biggest cause of flares from alcohol. It suggests these changes:

• Drink white wine instead of red
• Add soda or lemonade to white wine, beer and other drinks to lower the amount of alcohol
• Have no more than 1 or 2 drinks, with a large glass of cold water after each one
• Or do not drink alcohol at all

For spicy food, the AAD suggests trying a mild version of the dish, such as mild wings or mild salsa. If rosacea still flares, it says it is best to avoid spicy foods.

Stress

Stress is a common trigger on every list. The AAD reports a National Rosacea Society survey in which three quarters of people who answered said they reduced flare-ups by managing stress.

The AAD suggests finding an activity that relieves your stress and doing it often, such as tai chi, meditation or a rosacea support group. It also suggests doing something you enjoy every day, and in a stressful moment, taking a deep breath, holding it and breathing out slowly.

Wind and cold

The AAD says windburn is common in rosacea-prone skin and can trigger a flare, especially in winter. Cold can also trigger rosacea.

To protect your face, the AAD suggests covering it up to just below the eyes with a scarf. Silk or acrylic works best. Wool and other rough fabrics next to the face can cause a flare. Wear sunscreen and a moisturizing cream every day, limit time outdoors, and keep following your treatment plan.

Exercise

The AAD says exercise can trigger rosacea because it raises body temperature, and that you can still exercise. Its suggestions:

• Lower the intensity. A low or medium workout still helps your health.
• Exercise somewhere cool, such as an air-conditioned gym or a shaded path at the coolest time of day.
• Try swimming or water exercise in cool water.
• Bring a towel dipped in cold water for your neck, a bottle of cold water, or ice cubes.

Skin care, hair care and makeup

The AAD says to watch for products that make your face burn, sting or itch, or leave it dry and scaly. These are signs a product is irritating your skin. It recommends stopping astringents and toners, and checking skin and hair products for menthol, camphor and sodium lauryl sulfate. That last ingredient is common in shampoo and toothpaste.

For makeup, the AAD suggests a mild, fragrance-free moisturizing cream under a light liquid foundation that spreads easily and can be set with powder. It suggests avoiding waterproof makeup and heavy foundations that need makeup remover. The guide to skincare for rosacea has the full list of ingredients to avoid.

Medicines

Some medicines can make rosacea worse. The AAD names medicines used to treat high blood pressure, many types of heart problems, anxiety, migraines and glaucoma. It adds that vitamin B3 can also trigger a flare.

The AAD's advice here is firm. If you think a medicine is causing flares, do not stop taking it. First, ask the doctor who prescribed it whether it could be triggering your rosacea, and whether a different medicine could work for you.

How to find your own triggers

The AAD recommends a three-step process.

Step 1: make a short list. Look at the common triggers above and mark any that might affect you.

Step 2: collect the evidence. The AAD points to a free diary from the National Rosacea Society, filled in every day for at least 2 weeks. A notebook works too. Write down what you eat and drink, the products you put on your skin and hair, and what you were exposed to, such as heat, cold or sun. Also write down your symptoms and how strong they were. If you cannot tell when you flush, the AAD suggests asking a friend to tell you, or checking whether your cheeks feel warm.

Step 3: make changes. Compare the diary with your flares and see what matches. Then avoid or reduce what matches. NIH also recommends a written record to find triggers.

Tracking for a few weeks, or a few months, can show a pattern you would not notice day to day. The AAD says knowing your triggers and making changes can help you reduce flares, get better results from treatment and keep rosacea from getting worse.

Triggers in children

Children with rosacea have triggers too. The AAD says common triggers during childhood include hot or cold temperatures, hot drinks, spicy food, and skin care products that contain fragrance. It recommends checking the ingredients of anything that touches a child's skin, and avoiding products with sodium lauryl sulfate, menthol or camphor.

Flares can still happen

The AAD says flares can happen even when you treat rosacea and avoid your triggers. When one happens, see how to calm a rosacea flare-up for the steps the AAD suggests. If flares become more frequent or last longer, tell your dermatologist, because your treatment plan may need to change.